Provider Demographics
NPI:1730248022
Name:COLON RECTAL ASSOCIATES OF CENTRAL NEW YORK, LLP
Entity type:Organization
Organization Name:COLON RECTAL ASSOCIATES OF CENTRAL NEW YORK, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-458-2211
Mailing Address - Street 1:GLACIER CREEK OFFICE PARK - BLDG II
Mailing Address - Street 2:6711 TOWPATH RD., SUITE 175
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9510
Mailing Address - Country:US
Mailing Address - Phone:315-458-2211
Mailing Address - Fax:315-452-9025
Practice Address - Street 1:GLACIER CREEK OFFICE PARK - BLDG II
Practice Address - Street 2:6711 TOWPATH RD., SUITE 175
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9510
Practice Address - Country:US
Practice Address - Phone:315-458-2211
Practice Address - Fax:315-452-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY35708AMedicare UPIN